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This article, published in The Lancet, looks at the challenges involved in making health systems more equitable and examines a range of mechanisms for achieving this. The authors find that health systems are consistently inequitable, providing more and higher quality services to the well-off rather than to the poor, who need them more. They identify several measures that can help to resolve this inequity, including: establishing goals for improved coverage in the poor, rather than in entire populations, and use of those goals to direct planning toward the needs of the disadvantaged; use of one or more of the several techniques that have been effective in at least some settings; and empowering poor clients to play a more central role in health system design and operation.

The authors recommend that health policy makers experiment with a wide range of possibilities, monitor progress carefully to see how well they work, and retain those that prove effective. They acknowledge that this process is not guaranteed to bring greater efficiency in health systems. However, they suggest that equity in coverage is at least as important a basis for change as efficiency. [adapted from author]

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